Falling Funding for Tuberculosis Research Threatens to Derail TB Elimination Efforts in the United States

Falling Funding for Tuberculosis Research Threatens to Derail TB Elimination Efforts in the United States

Research Dollars Drop Just as Old Disease Grows More Difficult to Treat

Washington, D.C. – The goal of eliminating tuberculosis (TB) as a public health threat in the United States is under threat, a new policy brief released today by Treatment Action Group (TAG) shows. Analysis conducted by TAG reveals that spending on TB research and development (R&D) among U.S. government agencies declined from 2009 to 2012 in the face of budget instability, sequestration, and the rising costs of biomedical research.

U.S. federal agencies that fund TB research have all seen their budgets stagnate or fall below 2009 levels. The cost of research activities conducted by the National Institutes of Health increased by 7.4% between 2009 and 2012, yet the nominal amount spent on TB research by the NIH finished the period where it began, at less than $220 million. In 2013, sequestration forced the Centers for Disease Control and Prevention to reduce the budget of its Tuberculosis Trials Consortium by 13 percent, setting back plans to conduct a potentially groundbreaking phase III trial to shorten the length of TB treatment. TB research funding at the United States Agency for International Development fell from $19.8 million in 2010 to $12.2 million in 2012.

“History shows that declines in TB research spending are often followed by a resurgence in TB cases,” said Mark Harrington, executive director of TAG. “In the early 1990s, outbreaks of multidrug-resistant TB (MDR-TB) in New York City cost nearly $1 billion to overcome. A combination of research and implementation led us out of that epidemic, but once again we see political commitments for TB research wavering.”

On March 21, the New York City Department of Health and Mental Hygiene reported the first increase in the absolute number of TB cases in New York City in a decade—a reminder that progress against TB cannot be taken for granted. New York City has seen a 100 percent increase in the number of MDR-TB cases, from 9 in 2007 to 18 in 2012.

While the U.S. government remains the largest funder of TB R&D globally, annual spending on TB research remains far below the $2 billion the Stop TB Partnership estimates the world must spend on TB R&D each year in order to eliminate the disease. Globally, just $627.4 million was spent on TB R&D in 2012, leaving a shortfall of $1.39 billion.

TAG has tracked U.S. and global investments in TB R&D each year since 2005. In October 2013, TAG analysis uncovered the first drop in global spending on TB R&D since reporting began. This decline resulted from a 22 percent decrease in TB R&D spending among private-sector pharmaceutical companies. Since 2011, two companies, Pfizer and AstraZeneca, have left the TB research field entirely, while other drug companies have reduced their investments in TB research.

“Private-sector pullback from TB research is placing increased pressure on public agencies, which have seen their budgets steadily eroded by inflation,” said Colleen Daniels, director of TAG’s TB/HIV project. “Without reinvigorated investments in TB R&D, we run the risk that the emergence of drug-resistant TB will outpace the speed of drug- and diagnostic discovery.”

In 2012, the World Health Organization estimated that there were over 600,000 cases of MDR-TB worldwide. Although the majority of MDR-TB cases occur outside of the United States, the airborne nature of TB transmission and the stubborn persistence of the global TB epidemic mean that the U.S. government cannot afford to decrease funding for TB research and still hope to eliminate TB at home.

“New evidence suggests that the TB epidemic may be worse than we thought in certain vulnerable populations, including children,” said Erica Lessem, TAG’s TB/HIV project assistant director. On March 23, researchers from the Harvard Medical School published a study in the medical journal the Lancet estimating that 1 million children suffer from TB annually—twice the previous estimate from the World Health Organization. “Our reporting shows that research spending on childhood TB totaled a meager $10.3 million in 2012,” said Lessem. “This is woefully inadequate to respond to the burden of TB in children.”

U.S. lawmakers will soon have the opportunity to reverse this downward trend. On March 24, U.S. Representative Gene Green (D-TX) will introduce the Comprehensive Tuberculosis Elimination Act for reauthorization in the U.S. House of Representatives. The Act will authorize the development of new tools to diagnose, treat, and prevent TB and intensify basic and clinical research activities with the goal of TB elimination. Reauthorization of this Act offers an opportunity for national policy makers to put the United States back on track to eliminate TB, but this will require recommitting to TB research.

About TAG: Treatment Action Group is an independent AIDS research and policy think tank fighting for better treatment, a vaccine and a cure for AIDS. TAG works to ensure that all people with HIV receive lifesaving treatment, care, and information. We are science-based treatment activists working to expand and accelerate vital research and effective community engagement with research and policy institutions. TAG catalyzes open collective action by all affected communities, scientists, and policy makers to end AIDS.